AB0930 Psoriatic arthritis disease flares: is Covid-19 vaccination just an innocent bystander?
Authors: R. Bixio, I. Gavioli, D. Bertelle, F. Pistillo, D. Rotta, E. Bertoldo, E. Fracassi, M. Rossini, O. Viapiana
Journal: Annals of the Rheumatic Diseases (2022)

Background So far, few studies provided detailed data for the incidence of disease flare after the vaccination against Coronavirus (Covid)-19 in patients with psoriatic arthritis (PsA). Results from small cohorts report an incidence of flares after Covid-19 vaccination of 0-7.7% and disease activity does not seems to be influenced by Covid-19 vaccination in patients with PsA. However, since PsA is a highly fluctuating disease with prolonged remission and irregular reactivation, it is difficult to establish a causal relationship between the Covid-19 vaccination and disease flares. Objectives To define the impact of Covid-19 vaccination and disease activity on the incidence of disease flare in patients with psoriatic arthritis (PsA). Methods We prospectively evaluated patients with PsA in remission or low-disease activity candidate to receive Covid-19 vaccination with mRNA vaccines, collecting demographic, clinical, and therapeutic data and assessing DAPSA 28, PCR before and after vaccination. We assessed flares using patients and clinician concordance. We retrospectively evaluated flare incidence in the same timeframe of the previous year. We performed statistical analysis to find possible predictors of flares after vaccination. Results A total of 57 patients with PsA were prospectively evaluated, and retrospective analysis was possible for 53 of them. DAPSA 28 and CRP did not differ significantly before and after the vaccination. The incidence of flares in the two periods (2020 vs 2021) did not differ significantly (18.8% vs 8.8%, p=0.166). We found a higher basal mean DAPSA 28 in patients who flared up after vaccination (7.3 vs 4.1, p-value 0.046). Only having a flare in the previous year was associated with a higher chance of recurrence after Covid-19 vaccination (p=0.02) in the logistic regression analysis, while other predictors (age, gender, disease activity, ongoing DMARD therapy, ongoing bDMARD therapy) did not. Conclusion Our findings suggest that, in patients with PsA, disease activity could be the main driver of disease flares rather than Covid-19 vaccination. References [1]Furer V, Eviatar T, Zisman D, et al. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: a multicentre study. Ann Rheum Dis. 2021, 10:1330-1338. [2]Geisen UM, Berner DK, Tran F, et al. Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort. Ann Rheum Dis. 2021, 10:1306-1311. [3]Machado PM, Lawson-Tovey S, Strangfeld A, et al. Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry. Ann Rheum Dis 2021 Epub ahead of print. [4]Braun-Moscovici Y, Kaplan M, Braun M, et al (2021) Disease activity and humoral response in patients with inflammatory rheumatic diseases after two doses of the Pfizer mRNA vaccine against SARS-CoV-2. Ann Rheum Dis 80:1317–1321. [5]Spinelli FR, Favalli EG, Garufi C, et al. Low frequency of disease flare in patients with rheumatic musculoskeletal diseases who received SARS-CoV-2 mRNA vaccine. Arthritis Res Ther 2022, 24:21. Disclosure of Interests None declared